The bureaucratic-sounding rule 150-5-.03 has rekindled a sharp debate over limits on dental services for low-income Georgians. The Georgia Board of Dentistry, at a...

The bureaucratic-sounding rule 150-5-.03 has rekindled a sharp debate over limits on dental services for low-income Georgians.

The Georgia Board of Dentistry, at a meeting Friday, is expected to take up the proposed rule, which several health organizations say would unnecessarily restrict dental hygienists’ work in public health settings, such as school clinics.

The health groups say the provision, if approved, would require a dentist to examine a patient before a hygienist can apply sealants, clean teeth and perform other preventive dental services in a public health setting.

Currently, hygienists can travel to schools and Head Start centers without being accompanied by a dentist, the health groups point out. If a dentist had to examine each child first, it could add $500 more a day in expenses, making such trips cost-prohibitive, hygienists say.

“It would cost a lot more to operate the clinics,’’ says Janeime Asbury, president of the Georgia Dental Hygienists’ Association.

But the Georgia Dental Association, representing dentists, says the proposed change provides needed clarification of the rules of supervision for dental hygienists.

The organization supports allowing hygienists to apply fluoride varnishes or rinses without an exam by a dentist. Yet Martha Phillips, executive director of the Dental Association, also says, “I can’t see a logical reason why a dental hygienist cannot work under protocols where a child has been examined by a dentist.’’

“A dentist should have examined the patient at some point in the process,’’ Phillips adds. The Dental Association, in a letter to the board, also argues that the proper standard of care should not be compromised in public health dental settings.

The state Department of Public Health says a rule change would lead to public dental clinics serving fewer patients and having increased wait times for treatment.

“None of this is good in a state where dental services to the needy already are insufficient,’’ said Dr. Brenda Fitzgerald, the Public Health commissioner, in a letter to the Board of Dentistry opposing the rule change.

No one disputes that oral health is a problem in Georgia.

About 20 percent of Georgia third-graders have untreated tooth decay.

In 2007, there were about 60,000 visits to Georgia emergency rooms for “non-traumatic” dental problems — or oral health issues not caused by injuries. That cost more than $23 million.

More than 1.4 million Georgians live in areas designated as having a shortage of dentists, says Shelly Gehshan of the Pew Children’s Dental Campaign, citing federal statistics in a letter to the Georgia board. Yet Georgia’s rules governing hygienists are among the most stringent in the country, a Pew report says.

The board considered a similar rule change on supervising hygienists in January. The opposition included the Federal Trade Commission, which, in a letter stated that the revision “would harm the state’s most vulnerable consumers. The lack of dental care is a particular problem for children in rural and low-income communities.’’

The change was tabled by the Board of Dentistry, but the revised proposal became public in June.

“The existing regulation has worked well for many years,’’ Fitzgerald, the Public Health commissioner, says in her letter. “I am aware of no complaints or evidence of harm that would require new restrictions.’’

She said the change could affect the state’s teledentistry program, where a dentist uses videoconferencing to examine a patient who is with a hygienist at another location.

The need for dental services was underscored recently when a free two-day clinic for adults, held in Woodstock, attracted thousands of patients.

Hygienists point out that their mobile clinics target schools where more than 50 percent of children are on a free and reduced lunch program.

Those at greatest risk for oral health care problems are racial and ethnic minorities, children, people with special needs, older adults and the homeless, among others, says Dr. Harry Heiman, director of health policy at the Satcher Health Leadership Institute at Morehouse School of Medicine, in a letter to the dental board opposing the change.

The Board of Dentistry, comprised of nine dentists, one dental hygienist and one consumer member, has received many letters on the rule change.

Andy Miller

I find it ironic that many states are now considering legislation that would increase access to services delivered by dental hygienists to help alleviate the dental crisis, while the Georgia Board of Dentistry has been proposing a rule change that will further restrict access to such care for its citizens. Also of interest is the fact that the single hygienist who serves on the “Board” happens to be married to a dentist. Unfortunately, this particular “board member” does not represent the interests of Georgia’s dental hygienists.

Georgia is one of the most restrictive states in the country for dental hygienists. The Board of Dentistry sites “public safety” as the rationale for the stringent restrictions placed on hygienists but has NO evidence or research to support it; 29 states allow direct access to care, meaning the dental hygienist can initiate treatment based on assessment of patients’ needs without the specific authorization of a dentist, can treat the patient without the presence of a dentist and can maintain a provider-patient relationship, 44 states allow general supervision of hygienists, meaning that a dentist has authorized a dental hygienist to perform procedures but need not be present during those procedures and 44 states allow a dental hygienist to provide dental anesthetic for pain management.

Georgia’s indigent need heroes, policymakers willing to turn a blind eye to GDA’s deep pockets and approve legislation for the greater good. Research shows that better access to oral health professionals such as dental hygienists could wholly prevent or greatly reduce most oral disease. With Georgia’s poverty rate (the third-highest in the country), finding dental care for adult underserved has become almost impossible. It is time Georgia caught up with the rest of the nation by expanding the scope of practice for dental hygienists so that they may provide better care for our underserved.

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Georgia Health News is a nonprofit, independent news organization devoted to covering health care in the state. We are serious about our independence and are not affiliated with any political party, special interest organization or activist group. Our mission is to help fill the widening gap in media coverage by providing crucial information about health care in Georgia. GHN has received 501c3 status from the IRS.